Fol Med Indones, Vol. 54 No.

4 December 2018 : 278-281 Hanindito et al : Comparison of Length of Stay and DVT Incidents

COMPARISON OF LENGTH OF STAY AND DEEP VEIN THROMBOSIS (DVT) INCIDENTS IN

DR. SOETOMO HOSPITAL

Elizeus Hanindito1, Prananda Surya Airlangga1, Soni Sunarso Sulistiawan1, Bambang Pujo Semedi1, Lucky
Andriyanto1, Arie Utariani1, Nancy Margarita Rehatta2
1
Department of Anesthesiology and Reanimation, 2Professor of Anesthesiologist and Reanimation, Department of
Anesthesiology and Reanimation, Faculty of Medicine, Universitas Airlangga, Dr. Soetomo Hospital, Surabaya,
Indonesia

ABSTRACT

Vein thrombosis may occur both in deep and superficial vein of all extremities. Ninety percent of vein thrombosis may progress into
pulmonary embolism which is lethal. Deep vein thrombosis (DVT) is frequently found in critically ill patients in ICU, especially
patients who are treated for a long time. This study aims to analyse the comparison between length of stay and DVT incidents in
critically ill patients. A cross-sectional study was employed. We include all patients who were 18 years or older and were treated in
ICU of Dr Soetomo public hospital for at least 7 days. The patients were examined with Sonosite USG to look for any thrombosis in
iliac, femoral, popliteal, and tibial veins and Well’s criteria were also taken. This study showed that length of stay is not the only risk
factor for DVT in patients treated in ICU. In our data, we found out that the length of treatment did not significantly cause DVT.
Other risk factors such as age and comorbidities in patients who are risk factors may support the incidence of DVT events. The
diagnosis of DVT is enforced using an ultrasound performed by an expert in the use of ultrasound to locate thrombus in a vein.
Length of treatment is not a significant risk factor for DVT. Several other factors still need to be investigated in order for DVT events
to be detected early and prevented.

Keywords: Deep vein thrombosis (DVT); Intensive Care Unit (ICU); length of stay

ABSTRAK

Pembuluh darah vena dapat terjadi baik di vena dalam dan superfisial dari semua ekstremitas. Sembilan puluh persen dari
trombosis vena dapat berkembang menjadi emboli pulmonal yang mematikan. Trombosis vena dalam (DVT) sering ditemukan pada
pasien sakit kritis di ICU, terutama pasien yang dirawat untuk waktu yang lama. Penelitian ini bertujuan untuk menganalisis
perbandingan antara lama tinggal dan insiden DVT pada pasien sakit kritis. Sebuah studi cross-sectional digunakan. Kami termasuk
semua pasien yang berusia 18 tahun atau lebih dan dirawat di ICU rumah sakit umum Dr Soetomo selama setidaknya 7 hari. Para
pasien diperiksa dengan USG Sonosite untuk mencari setiap trombosis di vena iliaka, femoralis, poplitea, dan tibia dan kriteria Well
juga diambil. Penelitian ini menunjukkan bahwa lama tinggal bukan satu-satunya faktor risiko DVT pada pasien yang dirawat di
ICU. Dalam data kami, kami menemukan bahwa lama pengobatan tidak menyebabkan DVT secara bermakna. Faktor risiko lain
seperti usia dan komorbiditas pada pasien yang merupakan faktor risiko dapat mendukung kejadian kejadian DVT. Diagnosis DVT
ditegakkan menggunakan ultrasound yang dilakukan oleh seorang ahli dalam penggunaan USG untuk menemukan thrombus di
pembuluh darah. Lama pengobatan bukan faktor risiko yang signifikan untuk DVT. Beberapa faktor lain masih perlu diselidiki agar
kejadian DVT terdeteksi dini dan dicegah.

Kata kunci: Deep vein thrombosis (DVT); Intensive Care Unit (ICU); lama rawat inap

Correspondence: Elizeus Hanindito, Department of Anesthesiology and Reanimation, Faculty of Medicine Universitas
Airlangga, RSUD Dr. Soetomo, Jl. Mayjen Prof Dr. Moestopo 47 Surabaya, Indonesia. Phones: (031)5501835,
(031)5501504, 0811334332, 08155065323. E-mail: kppmanestesi.unair@gmail.com

pISSN:2355-8393 ● eISSN: 2599-056x ● doi: http://dx.doi.org/10.20473/fmi.v54i3.10004

● Fol Med Indones. 2018;54:278-281 ● Received 28 Aug 2017 ● Accepted 1 Feb 2018
● Open access under CC-BY-NC-SA license ● Available at https://e-journal.unair.ac.id/FMI/

INTRODUCTION deep venous thrombosis may develop into pulmonary

embolism, and in high-risk conditions can cause death
Venous thrombosis can occur in both deep and (Kaushansky et al 2010).
superficial veins in all four extremities. In 90% of cases,

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Fol Med Indones, Vol. 54 No. 4 December 2018 : 278-281 Hanindito et al : Comparison of Length of Stay and DVT Incidents

The incidence of venous thrombosis is approximately 1 MATERIALS AND METHODS

per population per year. In one-third cases manifest as
pulmonary embolism, whereas two-thirds are limited to
DVT. The mortality rate in DVT cases is 6% in cases of
pulmonary embolism as 1 month of DVT diagnosis and
pulmonary embolism is established (Cushman 2007). In
one study, it was found that the mortality rate from
pulmonary embolism was 30%, including cases of
pulmonary embolism diagnosed from the autopsy
(White, 2014) The formation, enlargement and
reshuffle of venous thromboembolism depends on the
balance between thrombogenic stimulation and
protective mechanism (thrombolytics).
A cross-sectional study was employed in ICU of Dr.
Soetomo public hospital. The study population included
all hospitalized patients who were 18 years or older and
were treated in ICU of Dr. Soetomo public hospital for
at least 7 days. Patients were included if they had a long
bed-rest and with a minimal activities in ICU because of
disease and treatment. The study was designed to enroll
a sample of at least 31 patients, which was considered
enough to estimate the true proportion of positive
patients who got deep vein thrombosis in long
hospitalized in ICU of Dr. Soetomo.

In 1859, Rudolph Virchow concluded that Data Collection

thrombogenic stimulation factors are blood flow stasis,
changes in blood vessel walls, and hypercoagulability. Data were collected on spesific period of time from
The mechanisms of thrombotic thrombus-induced June 2016 until June 2017 and took patients for samples
thrombogenic stimulation, particularly those related to without any specific diagnosis and treatment were given
damage to blood vessel walls, can be clearly illustrated to the patients, in conditions which the patients can be
in arterial thrombosis, but in the vein, the mechanism examined by intensivist in ICU for looking the
remains unclear. For example, in the Sevitt study, there possibility found the deep vein thrombosis in lower
was no evidence of damage to the vein wall in 49 of 50 extremities with a big vein anastomose, if there were
cases. It becomes interesting to discussed in this paper any wounds, unstable conscious, and minimalized
to explain the mechanism of venous thrombosis, movements it cannot be examined. So the intensivist
especially in intact veins (Lopez et al 2004) would looking for in the safe area until found any deep
vein thrombosis in enough time, so the patients did not
Clinical manifestations of venous thrombosis include disturbed until feel any pain or agited.
leg pain, tenderness, swelling, discoloration, venous
distention, superficial venous projection, and cyanosis Ultrasound examination
(Fauci et al 2008, Hirsh et al 1996, Kerr at al 1990).
However, clinical DVT diagnosis is not specific because The examination was performed by a certified
each of the symptoms above can be caused by intensivist. The Sonosite USG used to look for any
nontrombotic abnormalities (Kerr et al, 1990). Even in thrombosis in illiac, femoral, popliteal, and tibial veins.
some cases, DVT can occur without symptoms, until it If signs of thrombi in any size were considered positive.
eventually develops into pulmonary embolism and
causes sudden death (Hirsh et al 1986, Kerr et al 1990).
The unusual clinical symptoms of DVT and its RESULTS
complications that lead to death can even suddenly
occur, making DVT an interesting and important case The totally subjects were 31 patients enrolled, 19
for discussion, so it can be accurately diagnosed (Fauci patients with thrombus and 12 patients without
et al 2008, Hirsh et al 1986, Kerr at al 1990). thrombus. This study aims to analyse the comparison
between length of stay and DVT incidents in critically
Length of Stay (LOS) is one indicator of hospital ill patients.
service to measure the efficiency of hospital service.
Prolonged hospitalization not only increases Table 1. Population Data based on Age
maintenance costs and reduces hospital service
efficiency but also deals with other complications such Thrombus
Age Total P
as nosocomial infections, immobility, decubitus and Yes (%) No (%)
Deep Vein Thrombosis (DVT), which worsen the <15 years 0 (0%) 1 (100%) 1
quality of life of patients (Kerr et al, 1990). Therefore, 16-25 years 2 (50%) 2 (50%) 4
the objectives of this study was to examine the 26-40 years 1 (33.3%) 2 (66.7%) 3
41-55 years 13 (72.2%) 5 (27.8%) 18
association between time of hospitalization and the
>56 years 3 (60%) 2 (40%) 5
incidence of Deep Vein Thrombosis (DVT) in patients Total 19 (61.3%) 12 (38.7%) 31 0.449
with long hospitalization

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Fol Med Indones, Vol. 54 No. 4 December 2018 : 278-281 Hanindito et al : Comparison of Length of Stay and DVT Incidents

A total of 31 patients were hospitalized on the day of This study has several limitations. First, the
the study in ICU Dr. Soetomo Hospital. Based on Table insignificant differences in length of ICU admissions
1, the thrombus occurred mostly in a 41-55 years’ group and DVT events can be attributed to insufficient number
of patients (42%, n=13) and less occurred in an under of samples. In the calculation of the number of samples,
15 years’ group of patients (0%, n=0). But there is no the sample should be 422 patients. So it is necessary to
significant difference between categories because p make further research to increase the number of
value = 0.449 (>0.05). samples. Secondly, the study did not exclude patients
receiving anti-coagulant therapy, which may result in
Table 2. Characteristic Data based on Sex false-negative results in long-term beds but received
anticoagulant therapy which is often used as DVT
Thrombus prophylaxis. Third, we used USG as a tool to diagnose
Sex Total P
Yes (%) No (%) DVT. Ultrasonography is non-invasive and inexpensive.
Male 7 (41.2%) 10 (58.8%) 17 However, the sensitivity of screening ultrasound for
Female 5 (35.7%) 9 (64.3%) 14 venous thrombosis in asymptomatic patients was found
Total 12 (38.7%) 19 (61.3%) 31 0.525 to be poor for both proximal and distal DVT, because it
depends on the number of pathological compression
Based on Table 2, male patients are more often having a maneuvres documented in the ultrasound (Schellong et
thrombus than female patients (32%, n=10 vs 29%, al 2005).
n=9). But there is no significant difference between
male and female patients because p value = 0.525
(>0.05). CONCLUSION
Table 3. Length of Stay in ICU Length of treatment is not a significant risk factor for
DVT. Several other factors still need to be investigated
Length of Thrombus in order for DVT events to be detected early and
Total p
stay Yes (%) No (%)
prevented. Several factors, such as age and sex
1 week 5 (83.3%) 1 (16.7%) 6
influence DVT events can influence DVT events in
2 week 5 (45.5%) 6 (54.5%) 11
3 week 4 (57.1%) 3 (42.9%) 7 critically ill patient.
4-7 week 5 (71.4%) 2 (28.6%) 7
Total 19 (61.3) 12 (38.7%) 31 0.433
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DISCUSSION Cushman, M. 2007. Epidemiology and Risk Factors for

This study that the length of treatment did not
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